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Manuel K, Crotty M, Kurrle SE, Cameron ID, Lane R, Lockwood K, Block H, Sherrington C, Pond D, Nguyen TA, Laver K. Hospital-Based Health Professionals' Perceptions of Frailty in Older People. Gerontologist 2024:gnae041. [PMID: 38712983 DOI: 10.1093/geront/gnae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES There is a high prevalence of frailty amongst older patients in hospital settings. Frailty guidelines exist but implementation to date has been challenging. Understanding health professional attitudes, knowledge, and beliefs about frailty is critical in understanding barriers and enablers to guideline implementation and the aim of this study was to understand these in rehabilitation multidisciplinary teams in hospital settings. RESEARCH DESIGN AND METHODS Twenty-three semi-structured interviews were conducted with health professionals working in multi-disciplinary teams on geriatric and rehabilitation wards in Adelaide and Sydney, Australia. Interviews were audio recorded, transcribed, and coded by two researchers. A codebook was created and interviews re-coded and applied to the Framework Method of thematic analysis. RESULTS Three domains were developed: diagnosing frailty, communicating about frailty, and managing frailty. Within these domains, eight themes were identified: (1) diagnosing frailty has questionable benefits, (2) clinicians don't use frailty screening tools, (3) frailty can be diagnosed on appearance and history, (4) frailty has a stigma, (5) clinicians don't use the word "frail" with patients, (6) frailty isn't always reversible, (7) there is a lack of continuity of care after acute admission, and (8) the community setting lacks resources. DISCUSSION AND IMPLICATIONS Implementation of frailty guidelines will remain challenging while staff avoid using the term "frail", don't perceive benefit of using screening tools, and focus on the individual aspects of frailty rather than the syndrome holistically. Clinical champions and education about frailty identification, reversibility, management, and communication techniques may improve the implementation of frailty guidelines in hospitals.
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Affiliation(s)
- Kisani Manuel
- Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Ian D Cameron
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Lane
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather Block
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Tuan A Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Laver
- Rehabilitation, Aged and Palliative Care Service, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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Suen J, Dyer S, Shulver W, Ross T, Crotty M. A systematic review of typologies on aged care system components to facilitate complex comparisons. Health Serv Manage Res 2024; 37:123-134. [PMID: 37247254 DOI: 10.1177/09514848231179176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Objectives: Typologies are frequently utilised in analyses of the quality, funding, and efficiency of aged care systems. This review aims to provide a comprehensive resource identifying and critiquing existing aged care typologies. Methods: Systematic search of MEDLINE, Econlit, Google Scholar, greylit.org and Open Grey databases from inception to July 2020, including typologies of national, regional or provider aged care systems. Article screening, data extraction, and quality appraisal were conducted in duplicate. Results: 14 aged care typologies were identified; five applied to residential care, two to home care and seven to mixed settings; eight examined national systems and seven regional or provider systems. Five typologies classifying national financing or home care services, provider financing of staff and services and quality of residential care were considered high quality. The schematic provided summarises the focus area and aids in typology selection. Discussion: The aged care typologies identified cover a wide range of areas and contexts of aged care provision. This schematic, summary and critique will aid researchers, providers, and aged care policy makers to examine their own setting, compare it to other approaches to aged care provision and assist in identifying alternatives and important considerations, when undertaking aged care reform.
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Affiliation(s)
- Jenni Suen
- Flinders University, Bedford Park, AU-SA, Australia
| | - Suzanne Dyer
- Flinders University, Bedford Park, AU-SA, Australia
| | | | - Tyler Ross
- Flinders University, Bedford Park, AU-SA, Australia
| | - Maria Crotty
- Flinders University, Bedford Park, AU-SA, Australia
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Jorissen RN, Wesselingh SL, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M, Inacio MC. Predictors of mortality shortly after entering a long-term care facility. Age Ageing 2024; 53:afae098. [PMID: 38773946 PMCID: PMC11109518 DOI: 10.1093/ageing/afae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Moving into a long-term care facility (LTCF) requires substantial personal, societal and financial investment. Identifying those at high risk of short-term mortality after LTCF entry can help with care planning and risk factor management. This study aimed to: (i) examine individual-, facility-, medication-, system- and healthcare-related predictors for 90-day mortality at entry into an LTCF and (ii) create risk profiles for this outcome. DESIGN Retrospective cohort study using data from the Registry of Senior Australians. SUBJECTS Individuals aged ≥ 65 years old with first-time permanent entry into an LTCF in three Australian states between 01 January 2013 and 31 December 2016. METHODS A prediction model for 90-day mortality was developed using Cox regression with the purposeful variable selection approach. Individual-, medication-, system- and healthcare-related factors known at entry into an LTCF were examined as predictors. Harrell's C-index assessed the predictive ability of our risk models. RESULTS 116,192 individuals who entered 1,967 facilities, of which 9.4% (N = 10,910) died within 90 days, were studied. We identified 51 predictors of mortality, five of which were effect modifiers. The strongest predictors included activities of daily living category (hazard ratio [HR] = 5.41, 95% confidence interval [CI] = 4.99-5.88 for high vs low), high level of complex health conditions (HR = 1.67, 95% CI = 1.58-1.77 for high vs low), several medication classes and male sex (HR = 1.59, 95% CI = 1.53-1.65). The model out-of-sample Harrell's C-index was 0.773. CONCLUSIONS Our mortality prediction model, which includes several strongly associated factors, can moderately well identify individuals at high risk of mortality upon LTCF entry.
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Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - John Maddison
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - John Forward
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Alice Bourke
- Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Sluggett JK, Caughey GE, Air T, Cations M, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services. Int J Geriatr Psychiatry 2024; 39:e6089. [PMID: 38676658 DOI: 10.1002/gps.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES Dementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non-drug interventions fail, and to regularly review use. Population-level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC. METHODS Retrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011-12 to 2015-16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function. RESULTS Between 2011-12 and 2015-16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2-11.1) to 10.1% (95% CI 9.6-10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95-0.98)), and in PRAC residents from 24.5% (95% CI 24.2-24.7) to 21.8% (95% CI 21.5-22.0, aIRR 0.97 (95% CI 0.96-0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108-958) and 555 (IQR 197-1239) days, respectively. CONCLUSIONS While small decreases in antipsychotic use >90 days were observed between 2011-12 and 2015-16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Thapaliya K, Caughey GE, Crotty M, Williams H, Wesselingh SL, Roder D, Cornell V, Harvey G, Sluggett JK, Gill TK, Cations M, Khadka J, Kellie A, Inacio MC. Primary, allied health, selected specialists, and mental health service utilisation by home care recipients in Australia before and after accessing the care, 2017-2019. Aging Clin Exp Res 2024; 36:83. [PMID: 38551712 PMCID: PMC10980604 DOI: 10.1007/s40520-024-02731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES To examine changes in primary, allied health, selected specialists, and mental health service utilisation by older people in the year before and after accessing home care package (HCP) services. METHODS A retrospective cohort study using the Registry of Senior Australians Historical National Cohort (≥ 65 years old), including individuals accessing HCP services between 2017 and 2019 (N = 109,558), was conducted. The utilisation of general practice (GP) attendances, health assessments, chronic disease management plans, allied health services, geriatric, pain, palliative, and mental health services, subsidised by the Australian Government Medicare Benefits Schedule, was assessed in the 12 months before and after HCP access, stratified by HCP level (1-2 vs. 3-4, i.e., lower vs. higher care needs). Relative changes in service utilisation 12 months before and after HCP access were estimated using adjusted risk ratios (aRR) from Generalised Estimating Equation Poisson models. RESULTS Utilisation of health assessments (7-10.2%), chronic disease management plans (19.7-28.2%), and geriatric, pain, palliative, and mental health services (all ≤ 2.5%) remained low, before and after HCP access. Compared to 12 months prior to HCP access, 12 months after, GP after-hours attendances increased (HCP 1-2 from 6.95 to 7.5%, aRR = 1.07, 95% CI 1.03-1.11; HCP 3-4 from 7.76 to 9.32%, aRR = 1.20, 95%CI 1.13-1.28) and allied health services decreased (HCP 1-2 from 34.8 to 30.7%, aRR = 0.88, 95%CI 0.87-0.90; HCP levels 3-4 from 30.5 to 24.3%, aRR = 0.80, 95%CI 0.77-0.82). CONCLUSIONS Most MBS subsidised preventive, management and specialist services are underutilised by older people, both before and after HCP access and small changes are observed after they access HCP.
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Affiliation(s)
- Kailash Thapaliya
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gillian E Caughey
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David Roder
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Victoria Cornell
- School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | - Gillian Harvey
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Janet K Sluggett
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Tiffany K Gill
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
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Eshetie TC, Caughey GE, Whitehead C, Crotty M, Corlis M, Visvanathan R, Wesselingh S, Inacio MC. The risk of fractures after entering long-term care facilities. Bone 2024; 180:116995. [PMID: 38145862 DOI: 10.1016/j.bone.2023.116995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Stratifying residents at increased risk for fractures in long-term care facilities (LTCFs) can potentially improve awareness and facilitate the delivery of targeted interventions to reduce risk. Although several fracture risk assessment tools exist, most are not suitable for individuals entering LTCF. Moreover, existing tools do not examine risk profiles of individuals at key periods in their aged care journey, specifically at entry into LTCFs. PURPOSE Our objectives were to identify fracture predictors, develop a fracture risk prognostic model for new LTCF residents and compare its performance to the Fracture Risk Assessment in Long term care (FRAiL) model using the Registry of Senior Australians (ROSA) Historical National Cohort, which contains integrated health and aged care information for individuals receiving long term care services. METHODS Individuals aged ≥65 years old who entered 2079 facilities in three Australian states between 01/01/2009 and 31/12/2016 were examined. Fractures (any) within 365 days of LTCF entry were the outcome of interest. Individual, medication, health care, facility and system-related factors were examined as predictors. A fracture prognostic model was developed using elastic nets penalised regression and Fine-Gray models. Model discrimination was examined using area under the receiver operating characteristics curve (AUC) from the 20 % testing dataset. Model performance was compared to an existing risk model (i.e., FRAiL model). RESULTS Of the 238,782 individuals studied, 62.3 % (N = 148,838) were women, 49.7 % (N = 118,598) had dementia and the median age was 84 (interquartile range 79-89). Within 365 days of LTCF entry, 7.2 % (N = 17,110) of individuals experienced a fracture. The strongest fracture predictors included: complex health care rating (no vs high care needs, sub-distribution hazard ratio (sHR) = 1.52, 95 % confidence interval (CI) 1.39-1.67), nutrition rating (moderate vs worst, sHR = 1.48, 95%CI 1.38-1.59), prior fractures (sHR ranging from 1.24 to 1.41 depending on fracture site/type), one year history of general practitioner attendances (≥16 attendances vs none, sHR = 1.35, 95%CI 1.18-1.54), use of dopa and dopa derivative antiparkinsonian medications (sHR = 1.28, 95%CI 1.19-1.38), history of osteoporosis (sHR = 1.22, 95%CI 1.16-1.27), dementia (sHR = 1.22, 95%CI 1.17-1.28) and falls (sHR = 1.21, 95%CI 1.17-1.25). The model AUC in the testing cohort was 0.62 (95%CI 0.61-0.63) and performed similar to the FRAiL model (AUC = 0.61, 95%CI 0.60-0.62). CONCLUSIONS Critical information captured during transition into LTCF can be effectively leveraged to inform fracture risk profiling. New fracture predictors including complex health care needs, recent emergency department encounters, general practitioner and consultant physician attendances, were identified.
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Affiliation(s)
- Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Harrison SL, Lang C, Eshetie TC, Crotty M, Whitehead C, Evans K, Corlis M, Wesselingh S, Caughey GE, Inacio MC. Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia. AUST HEALTH REV 2024; 48:182-190. [PMID: 38537302 DOI: 10.1071/ah24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8-43.3], vs 37.8% [37.6-38.0]), unplanned hospitalisation (39.8% [39.6-40.1] vs 33.4% [33.2-33.6]) and potentially preventable hospitalisation (11.8% [11.6-12.0] vs 8.2% [8.1-8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.
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Affiliation(s)
- Stephanie L Harrison
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; and UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, SA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Taylor ME, Harvey LA, Crotty M, Harris IA, Sherrington C, Close JCT. Variation in care and outcomes for people after hip fracture with and without cognitive impairment; results from the Australian and New Zealand Hip Fracture Registry. J Nutr Health Aging 2024; 28:100030. [PMID: 38388111 DOI: 10.1016/j.jnha.2023.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND People with dementia have poorer outcomes after hip fracture and this may be due in part to variation in care. We aimed to compare care and outcomes for people with and without cognitive impairment after hip fracture. METHODS Retrospective cohort study using Australian and New Zealand Hip Fracture Registry data for people ≥50 years of age who underwent hip fracture surgery (n = 49,063). Cognitive impairment or known dementia and cognitively healthy groups were defined using preadmission cognitive status. Descriptive statistics and multivariable mixed effects models were used to compare groups. RESULTS In general, cognitively impaired people had worse care and outcomes compared to cognitively healthy older people. A lower proportion of the cognitively impaired group had timely pain assessment (≤30 min of presentation: 61% vs 68%; p < 0.0001), were given the opportunity to mobilise (89% vs 93%; p < 0.0001) and achieved day-1 mobility (34% vs 58%; p < 0.0001) than the cognitively healthy group. A higher proportion of the cognitively impaired group had delayed pain management (>30 mins of presentation: 26% vs 20%; p < 0.0001), were malnourished (27% vs 15%; p < 0.0001), had delirium (44% vs 13%; p < 0.0001) and developed a new pressure injury (4% vs 3%; p < 0.0001) than the cognitively healthy group. Fewer of the cognitively impaired group received rehabilitation (35% vs 64%; p < 0.0001), particularly patients from RACFs (16% vs 39%; p < 0.0001) and were prescribed bone protection medication on discharge (24% vs 27%; p < 0.0001). Significantly more of the cognitively impaired group had a new transfer to residential care (46% vs 11% from private residence; p < 0.0001) and died at 30-days (7% vs 3% from private residence; 15% vs 10% from RACF; both p < 0.0001). In multivariable models adjusting for covariates with facility as the random effect, the cognitively impaired group had a greater odds of being malnourished, not achieving day-1 walking, having delirium in the week after surgery, dying within 30 days, and in those from private residences, having a new transfer to a residential care facility than the cognitively healthy group. CONCLUSIONS We have identified several aspects of care that could be improved for patients with cognitive impairment - management of pain, mobility, nutrition and bone health, as well as delirium assessment, prevention and management strategies and access to rehabilitation. Further research is needed to determine whether improvements in care will reduce hospital complications and improve outcomes for people with dementia after hip fracture.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; UNSW Ageing Futures Research Institute, Sydney, New South Wales, Australia.
| | - Lara A Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool Hospital, Liverpool, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Caughey GE, Rahja M, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Harvey G, Sluggett JK, Gill TK, Kadkha J, Roder D, Kellie AR, Wesselingh S, Inacio MC. Primary health care service utilisation before and after entry into long-term care in Australia. Arch Gerontol Geriatr 2024; 117:105210. [PMID: 37812974 DOI: 10.1016/j.archger.2023.105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. METHODS A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0-3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. RESULTS 235,217 residents were included in the study with a median age of 84 years (interquartile range 79-89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10-1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70-1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81-1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. CONCLUSION There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met.
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Affiliation(s)
- Gillian E Caughey
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
| | - Miia Rahja
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Luke Collier
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tracy Air
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Kailash Thapaliya
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Gillian Harvey
- College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - Janet K Sluggett
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Tiffany K Gill
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jyoti Kadkha
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - David Roder
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | | | - Steve Wesselingh
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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10
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Greene L, Crotty M, Whitehead C, Rahja M, Murad J, Dang K, Partington A, Laver K. Assessing the reach and safety of an innovative urgent care service tailored to older adults. Australas J Ageing 2024. [PMID: 38268230 DOI: 10.1111/ajag.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024]
Abstract
Traditional emergency departments (EDs) are overcrowded and sometimes not suitable for older adults with complex needs. Specialised geriatric urgent care pathways for selected patients can alleviate ED demand and improve patient experience. To address urgent care needs for older adults in Southern Adelaide, the Complex And RestorativE (CARE) service was established. CARE offers alternative, geriatrician-led treatment pathways consisting of a ward-based treatment centre and an in-home visiting team called Eyes on Scene (EoS). Both pathways offer medical, nursing and allied health treatment. Routinely collected clinical data were analysed to explore the reach of the service and the incidence and nature of adverse events. Between September 2021 and March 2023, the CARE service attended to 5324 older adults requiring urgent care. A significant proportion of patients were discharged to or remained in their regular place of residence, with few requiring inpatient admissions or referrals to other facilities. A total of 7% of patients required transfer to ED and adverse events were rare. The CARE service demonstrates a feasible and safe alternative model of urgent care for older Australians.
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Affiliation(s)
- Leanne Greene
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Miia Rahja
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Javaria Murad
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kwok Dang
- The Complex and RestorativE (CARE) Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Andrew Partington
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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11
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Pham BD, Kim BG, Esterman A, Brodaty H, Kurrle S, Nguyen TB, Nguyen TH, Roughead E, Hinton L, Dang TH, Nguyen TDH, Tran K, Crotty M, Du D, Nguyen TA. Knowledge, attitudes and self-confidence with skills required for providing dementia care in physicians at primary healthcare settings in Vietnam. BMC Health Serv Res 2024; 24:86. [PMID: 38233921 PMCID: PMC10792887 DOI: 10.1186/s12913-023-10460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Dementia is a global public health priority. The World Health Organization adopted a Global Action Plan on Dementia, with dementia awareness a priority. This study examined the knowledge, attitudes, and self-confidence with skills required for providing dementia care among primary health care providers in Vietnam. METHODS A cross-sectional study was conducted with 405 primary health care providers who worked at commune health stations and district health centers in eight provinces across Vietnam. RESULTS The results showed that primary health care providers had poor knowledge and little confidence but more positive attitudes toward dementia care and management. CONCLUSIONS The results suggest the training needs for building capacity amongst primary health care providers, which will be critical as Vietnam's population ages.
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Affiliation(s)
- Bich Diep Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Bao Giang Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - Adrian Esterman
- UniSA: Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Kurrle
- The University of Sydney, Sydney, NSW, Australia
| | | | | | - Elizabeth Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- University of California, Davis, Sacramento, CA, USA
| | - Thu Ha Dang
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Thi Diem Huong Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Kham Tran
- National Ageing Research Institute, Melbourne, VIC, Australia
- Flinders University, Adelaide, SA, Australia
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | | | - Duc Du
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tuan Anh Nguyen
- Swinburne University of Technology, Melbourne, VIC, Australia
- National Ageing Research Institute, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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12
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Shafei I, Karnon J, Crotty M. Process mining and customer journey mapping in healthcare: Enhancing patient-centred care in stroke rehabilitation. Digit Health 2024; 10:20552076241249264. [PMID: 38766357 PMCID: PMC11102702 DOI: 10.1177/20552076241249264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/08/2024] [Indexed: 05/22/2024] Open
Abstract
Background Patient-centred care and enhancing patient experience is a priority across Australia. Stroke rehabilitation has multiple consumer touchpoints that would benefit from a better understanding of customer journeys, subsequently impacting better patient-centred care, and contributing to process improvements and better patient outcomes. Customer journey mapping through process mining extracts process data from event logs in existing information systems discovering patient journeys, which can be utilized to monitor guideline compliance and uncover nonconformance. Methodology Utilizing process mining and variant analysis, customer journey maps were developed for 130 stroke rehabilitation patients from referral to discharge. In total, 168 cases from the Australasian Rehabilitation Outcomes Centre dataset were matched with 6291 cases from inpatient stroke data. Variants were explored for age, gender, outcome measures, length of stay and functional independence measure (FIM) change. Results The study illustrated the process, process variants and patient journey map in stroke rehabilitation. Process characteristics of stroke rehabilitation patients were extracted and represented utilizing process mining and results highlighted process variation, attributes, touchpoints and timestamps across stroke rehabilitation patient journeys categorized by patient demographics and outcome variables. Patients demonstrated a mean and median duration of 49.5 days and 44 days, respectively, across the patient journeys. Nine variants were discovered, with 78.46% (n = 102) of patients following the expected sequence of activities in their stroke rehabilitation patient journey. Relationships involving age, gender, length of stay and FIM change along the patient journeys were evident, with four cases experiencing stroke rehabilitation journeys of more than 100 days, warranting further investigation. Conclusion Process mining can be utilized to visualize and analyse patient journeys and identify gaps in service quality, thus contributing to better patient-centred care and improved patient outcomes and experiences in stroke rehabilitation.
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Affiliation(s)
- Ingy Shafei
- The University of Adelaide, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
| | - Jonathan Karnon
- The University of Adelaide, Adelaide, SA, Australia
- Flinders University, Adelaide, SA, Australia
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13
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Smith TO, Khoury R, Hanson S, Welsh A, Grant K, Clark AB, Ashford PA, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa ML, Lamb S. Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England. BMJ Open 2023; 13:e073611. [PMID: 38070926 PMCID: PMC10729129 DOI: 10.1136/bmjopen-2023-073611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. DESIGN Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. SETTING National Health Service (NHS) providers in five English hospitals. PARTICIPANTS Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. INTERVENTION Usual care: usual NHS care. EXPERIMENTAL usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. RANDOMISATION AND BLINDING Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. MAIN OUTCOME MEASURES Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. RESULTS 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. CONCLUSIONS The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site's ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. TRIAL REGISTRATION NUMBER ISRCTN13270387.
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Affiliation(s)
- Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Kelly Grant
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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14
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Cations M, Lang C, Draper B, Caughey GE, Evans K, Wesselingh S, Crotty M, Whitehead C, Inacio MC. Death by suicide among aged care recipients in Australia 2008-2017. Int Psychogeriatr 2023; 35:724-735. [PMID: 36803904 DOI: 10.1017/s104161022300008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To characterize the features of aged care users who died by suicide and examine the use of mental health services and psychopharmacotherapy in the year before death. DESIGN Population-based, retrospective exploratory study. SETTING AND PARTICIPANTS Individuals who died while accessing or waiting for permanent residential aged care (PRAC) or home care packages in Australia between 2008 and 2017. MEASUREMENTS Linked datasets describing aged care use, date and cause of death, health care use, medication use, and state-based hospital data collections. RESULTS Of 532,507 people who died, 354 (0.07%) died by suicide, including 81 receiving a home care package (0.17% of all home care package deaths), 129 in PRAC (0.03% of all deaths in PRAC), and 144 approved for but awaiting care (0.23% of all deaths while awaiting care). Factors associated with death by suicide compared to death by another cause were male sex, having a mental health condition, not having dementia, less frailty, and a hospitalization for self-injury in the year before death. Among those who were awaiting care, being born outside Australia, living alone, and not having a carer were associated with death by suicide. Those who died by suicide more often accessed Government-subsidized mental health services in the year before their death than those who died by another cause. CONCLUSIONS Older men, those with diagnosed mental health conditions, those living alone and without an informal carer, and those hospitalized for self-injury are key targets for suicide prevention efforts.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- College of Education, Psychology and Social Work, Flinders University, AdelaideSA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Brian Draper
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, SydneyAustralia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, AdelaideSA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, AdelaideSA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, AdelaideSA, Australia
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15
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Luker S, Laver K, Lane R, Potter E, Harrod A, Bierer P, Adey-Wakeling Z, Karnon J, Cameron ID, Crotty M. 'Put in a room and left': a qualitative study exploring the lived experiences of COVID-19 isolation and quarantine among rehabilitation inpatients. Ann Med 2023; 55:198-206. [PMID: 36538037 PMCID: PMC9788724 DOI: 10.1080/07853890.2022.2155698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic has resulted in significant changes to health care delivery and the patient's experience in hospital. Changes for those who contracted COVID-19 or were close contacts included isolation and quarantine, visitor restrictions and changes to usual models of care to reduce viral transmission. Traditional models of inpatient rehabilitation utilise communal spaces (e.g. shared gyms and dining rooms) and involve a multidisciplinary team interacting with the patient daily. OBJECTIVES To report the experience of COVID-19 related isolation and quarantine among rehabilitation inpatients and their family members who experienced a nosocomial outbreak and to make recommendations for rehabilitation units. METHODS A qualitative phenomenological methodology using semi-structured telephone interviews. RESULTS 19 semi-structured interviews were conducted comprising of 13 general rehabilitation inpatients and 6 family members. Five themes were established: (1) the impact of social and physical isolation; (2) boredom and limited access to therapy; (3) the impact of technology; (4) inadequate information sharing and (5) positive experiences and things done well. Several novel insights were identified including: the desire for increased social interaction from staff to compensate for a lack of visitors; the impact of physical and cognitive deficits on a patient's ability to reach basic items around their room or call for help, and the unique impact of isolation and quarantine on individuals who have a history of trauma, discrimination or mental illness. CONCLUSIONS This study establishes key areas that should be considered by rehabilitation units globally to adjust traditional models which are not suitable in this pandemic. Strategies to mitigate the impact of isolation include providing training to increase use of technologies such as tablet devices, increased staff social engagement to reduce isolation and tailoring the environment to suit specific patient groups.KEY MESSAGESCOVID-19 related isolation and quarantine has a significant and unique impact on patients with cognitive and physical impairments such as those in inpatient rehabilitation. Patients who are required to isolate in inpatient settings expressed a desire for compensatory increased social interaction from staff and required specific assistance with basic daily tasks while isolated. The study makes key recommendations for other rehabilitation units to integrate into their approach for managing patients required to isolate or quarantine.
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Affiliation(s)
- Subbuh Luker
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rachel Lane
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Elizabeth Potter
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia
| | - AnnMarie Harrod
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia
| | - Petra Bierer
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia
| | - Zoe Adey-Wakeling
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
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16
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Welsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, Hopewell S, Logan P, Crotty M, Costa M, Lamb S, Smith T, Hip Helper Study C. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open 2023; 13:e074095. [PMID: 37977867 PMCID: PMC10660837 DOI: 10.1136/bmjopen-2023-074095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to illuminate the perspectives of informal caregivers who support people following hip fracture surgery. DESIGN A qualitative study embedded within a now completed multicentre, feasibility randomised controlled trial (HIP HELPER). SETTING Five English National Health Service hospitals. PARTICIPANTS We interviewed 20 participants (10 informal caregivers and 10 people with hip fracture), following hip fracture surgery. This included one male and nine females who experienced a hip fracture; and seven male and three female informal caregivers. The median age was 72.5 years (range: 65-96 years), 71.0 years (range: 43-81 years) for people with hip fracture and informal caregivers, respectively. METHODS Semistructured, virtual interviews were undertaken between November 2021 and March 2022, with caregiver dyads (person with hip fracture and their informal caregiver). Data were analysed thematically. FINDINGS We identified two main themes: expectations of the informal caregiver role and reality of being an informal caregiver; and subthemes: expectations of care and services; responsibility and advocacy; profile of people with hip fracture; decision to be a caregiver; transition from hospital to home. CONCLUSION Findings suggest informal caregivers do not feel empowered to advocate for a person's recovery or navigate the care system, leading to increased and unnecessary stress, anxiety and frustration when supporting the person with hip fracture. We suggest that a tailored information giving on the recovery pathway, which is responsive to the caregiving population (ie, considering the needs of male, younger and more active informal caregivers and people with hip fracture) would smooth the transition from hospital to home. TRIAL REGISTRATION NUMBER ISRCTN13270387.Cite Now.
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Affiliation(s)
- Allie Welsh
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Reema Khoury
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sallie Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Toby Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- University of Warwick, Coventry, UK
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Suen J, Kneale D, Sutcliffe K, Kwok W, Cameron ID, Crotty M, Sherrington C, Dyer S. Critical features of multifactorial interventions for effective falls reduction in residential aged care: a systematic review, intervention component analysis and qualitative comparative analysis. Age Ageing 2023; 52:afad185. [PMID: 37993405 PMCID: PMC10665139 DOI: 10.1093/ageing/afad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Multifactorial fall prevention trials providing interventions based on individual risk factors have variable success in aged care facilities. To determine configurations of trial features that reduce falls, intervention component analysis (ICA) and qualitative comparative analysis (QCA) were undertaken. METHODS Randomised controlled trials (RCTs) from a Cochrane Collaboration review (Cameron, 2018) with meta-analysis data, plus trials identified in a systematic search update to December 2021 were included. Meta-analyses were updated. A theory developed through ICA of English publications of trialist's perspectives was assessed through QCA and a subgroup meta-analysis. RESULTS Pooled effectiveness of multifactorial interventions indicated a falls rate ratio of 0.85 (95% confidence interval, CI, 0.65-1.10; I2 = 85%; 11 trials). All tested interventions targeted both environmental and personal risk factors by including assessment of environmental hazards, a medical or medication review and exercise intervention. ICA emphasised the importance of co-design involving facility staff and managers and tailored intervention delivery to resident's intrinsic factors for successful outcomes. QCA of facility engagement plus tailored delivery was consistent with greater reduction in falls, supported by high consistency (0.91) and coverage (0.85). An associated subgroup meta-analysis demonstrated strong falls reduction without heterogeneity (rate ratio 0.61, 95%CI 0.54-0.69, I2 = 0%; 7 trials). CONCLUSION Multifactorial falls prevention interventions should engage aged care staff and managers to implement strategies which include tailored intervention delivery according to each resident's intrinsic factors. Such approaches are consistently associated with a successful reduction in falls, as demonstrated by QCA and subgroup meta-analyses. Co-design approaches may also enhance intervention success.
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Affiliation(s)
- Jenni Suen
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
| | - Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London WC1H 0NS, United Kingdom
| | - Katy Sutcliffe
- EPPI Centre, UCL Social Research Institute, University College London, London WC1H 0NS, United Kingdom
| | - Wing Kwok
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and the University of Sydney, St Leonards, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Suzanne Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University of South Australia, Bedford Park, Australia
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18
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Inacio MC, Eshetie TC, Caughey GE, Whitehead C, Westbrook J, Gray L, Hibbert P, Beattie E, Braithwaite J, Cameron ID, Crotty M, Wesselingh S. Quality and safety in residential aged care: an evaluation of a national quality indicator programme. Intern Med J 2023; 53:2073-2078. [PMID: 36878881 PMCID: PMC10946472 DOI: 10.1111/imj.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/13/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. AIM To examine the validity of the QI programme indicators using explicit measure review criteria. METHODS The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine-point scale. A median score of 1-3 was considered to not meet criteria, 4-6 to meet some criteria and 7-9 to meet criteria. RESULTS All indicators, except polypharmacy, met criteria (median scores = 7-9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2-8), appropriateness (median = 5, range 2-8) and clinical evidence (median = 6, range 3-8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6-7, range 4-8) and met criteria for feasibility and applicability (median = 7, range 4-8). CONCLUSIONS Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes.
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Affiliation(s)
- Maria C. Inacio
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Tesfahun C. Eshetie
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Clinical & Health SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Gillian E. Caughey
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Craig Whitehead
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Len Gray
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Elizabeth Beattie
- School of Nursing, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Ian D. Cameron
- John Walsh Centre for Rehabilitation ResearchUniversity of SydneySydneyNew South WalesAustralia
| | - Maria Crotty
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | - Steve Wesselingh
- Registry of Senior AustraliansSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
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Kosowicz L, Tran KV, Brodaty H, Roughead E, Esterman A, Hinton L, Kim GB, Kurrle S, Dang TH, Crotty M, Gilbert A, Tan E, Nguyen TA. Vietnam's Responses to Dementia - An Assessment of Service Delivery. Dementia (London) 2023; 22:1372-1391. [PMID: 37621009 DOI: 10.1177/14713012231181167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND This study was conducted to assess Vietnam's dementia service delivery. METHODS Using WHO methodology, website searches of key organisations focused on three aspects of Vietnam's healthcare system: (1) Health and social workforce; (2) Services, supports and treatment programs; and (3) Promotion of awareness and understanding. Data were analysed using content analysis. RESULTS While key members of the healthcare workforce receive some education in dementia competencies during their training, the skill-mix of staff in the current workforce appears inadequate to address the complex needs of people with dementia. Although Vietnam's general healthcare system comprises a good variety of service types, there is a lack of dementia-specific services. Available diagnosis and treatment services are concentrated in the hospital system and are mainly located in metropolitan areas, impacting their accessibility. While both community-based and institutional long-term care is available, institutional care is not universally accessible and home-based care is mainly provided by family carers who don't have access to dementia care training. There is no active dementia prevention or public awareness campaign. CONCLUSIONS To improve the ability of Vietnam's service delivery to meet the needs of people with dementia and their carers, the skill-mix of the healthcare workforce should be strengthened by ensuring that dementia core competencies are embedded within undergraduate and graduate education programs and making post-qualification dementia care training available. The capacity of existing community-level health and social services should be expanded to ensure that integrated, specialised and comprehensive health and social services are accessible to all people with dementia. Expanding access to institutional long-term care and making dementia education available to family and other informal carers could increase choice and improve quality of care. Finally, Vietnam could look to other countries in the region with regards to the development of a dementia prevention and public awareness campaign.
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Affiliation(s)
- Leona Kosowicz
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Kham Van Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- University of South Australia, Adelaide, SA, Australia
| | - Henry Brodaty
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Roughead
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ladson Hinton
- School of Medicine, University of California, Davis, Sacramento, CA, USA
| | | | - Susan Kurrle
- Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Andrew Gilbert
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Esther Tan
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
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20
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Rahja M, Laver K, Mordaunt DA, Adnan N, Vakulin A, Lovato N, Crotty M. "The Days Are Long But the Nights Are Even Longer": A Mixed-Method Study of Sleep Disturbances Among Patients in an Inpatient Rehabilitation Program. Arch Rehabil Res Clin Transl 2023; 5:100275. [PMID: 37744205 PMCID: PMC10517360 DOI: 10.1016/j.arrct.2023.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To assess sleep quality of patients on a rehabilitation ward and to identify staff practices and beliefs about management of sleep disturbance. Design Mixed-methods design including patient surveys and staff interviews. Setting Inpatient rehabilitation ward in a tertiary teaching hospital in Adelaide, Australia. Participants Of the 345 screened inpatients who had been in a mixed post-acute rehabilitation ward for at least 5 days, 120 (43% women) were included. The mean age was 67.7 years and the main admission reason was functional decline (40%). Patients with stroke or traumatic brain injury were excluded. Eleven (n = 11) staff (a mix of doctors, nurses, and allied health) were interviewed. Main Outcome Measures The surveys comprised of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Flinders Fatigue Scale, and the Sleep Inertia Questionnaire. The survey results were compared with functional outcomes using the functional independence measure (FIM). Staff interviews delved into barriers to good sleep, ward practices, and knowledge about sleep hygiene. Results 43% of the surveyed patients reported having healthy amount of sleep. Sleep quality was not significantly correlated with rehabilitation outcomes (assessed using FIM). Staff reported having a good awareness of sleep hygiene; however, acknowledged limitations about the environment and routine which were not conducive to healthy sleep. They identified several actions which could be taken to improve patients' sleep hygiene. Conclusions Sleep disturbance is common for patients in rehabilitation. Rehabilitation wards should address this often-neglected critical component of rehabilitation to improve patient experience and potential participation in therapy. Introducing a systematic approach for assessing sleep during admission, establishing clear roles regarding sleep assessment and intervention among staff, and ensuring that patients and staff are aware of good sleep hygiene practices may promote better sleep during inpatient rehabilitation.
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Affiliation(s)
- Miia Rahja
- Flinders Health and Medical Research Institute, Flinders University, Flinders Drive Bedford Park, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Flinders University, Flinders Drive Bedford Park, Australia
| | - Dylan A. Mordaunt
- Flinders Health and Medical Research Institute, Flinders University, Flinders Drive Bedford Park, Australia
- Department of Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Bedford Park, Australia
| | - Nurul Adnan
- Department of Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Bedford Park, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute Sleep Health, Flinders University, Bedford Park, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute Sleep Health, Flinders University, Bedford Park, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Flinders Drive Bedford Park, Australia
- Department of Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Bedford Park, Australia
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21
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Greene L, Lane R, Crotty M, Whitehead C, Potter E, Bierer P, Laver K. Evaluating a new emergency department avoidance service for older people: patient and relative experiences. Emerg Med J 2023; 40:641-645. [PMID: 37400224 PMCID: PMC10447360 DOI: 10.1136/emermed-2022-212949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND High emergency department (ED) usage by older individuals for non-emergencies is a global concern. ED avoidance initiatives have proven effective in addressing this issue. To specifically cater to individuals aged 65 and above, the Southern Adelaide Local Health Network introduced an innovative ED avoidance service. This study assessed the acceptability of the service among its users. METHOD The Complex And RestorativE (CARE) Centre is a six-bed unit staffed by a multidisciplinary geriatric team. Patients are transported directly to CARE after calling for an ambulance and being triaged by a paramedic. The evaluation took place between September 2021 and September 2022. Semi-structured interviews were conducted with patients and relatives who had accessed the service. Data analysis was performed using a six-step thematic analysis. RESULTS Seventeen patients and 15 relatives were interviewed, who described the experience of 32 attendances to the urgent CARE centre between them. Patients accessed the service for several reasons but over half were associated with falls. There was a hesitation to call emergency services for several reasons, the primary being long wait times in ED and/or the prospect of an overnight stay in hospital. Some individuals attempted to contact their General Practitioner (GP) for the presenting problem but were unable to get a timely appointment. Most participants had previously attended a local ED and had a negative experience. All individuals reported favouring the CARE centre over the traditional ED for numerous reasons including a quieter and safer environment and specially trained geriatric staff who were less rushed than ED staff. Several participants would have appreciated a standardised follow-up process after discharge. CONCLUSION Our findings suggest that ED admission avoidance programmes may be an acceptable alternative treatment for older people requiring urgent care, potentially benefiting both public health systems and user experience.
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Affiliation(s)
- Leanne Greene
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Lane
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Potter
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Petra Bierer
- Rehabilitation, Aged and Extended Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Kate Laver
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
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22
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Inacio MC, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Wesselingh SL, Kellie A, Roder D, Lewis A, Harvey G, Sluggett JK, Cations M, Gill TK, Khadka J, Caughey GE. Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017. Australas J Ageing 2023; 42:564-576. [PMID: 37070244 PMCID: PMC10947441 DOI: 10.1111/ajag.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. METHODS Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). RESULTS In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. CONCLUSIONS The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.
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Affiliation(s)
- Maria C. Inacio
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Luke Collier
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Tracy Air
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Kailash Thapaliya
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
| | - Maria Crotty
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Southern Adelaide Local Health NetworkSA HealthAdelaideSouth AustraliaAustralia
| | | | - Steve L. Wesselingh
- South Australian Health and Medical Research Institute (SAHMRI)AdelaideSouth AustraliaAustralia
| | - Andrew Kellie
- East Adelaide HealthcareNewtonSouth AustraliaAustralia
| | - David Roder
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Adrienne Lewis
- SA Health Dental ServiceAdelaideSouth AustraliaAustralia
| | - Gillian Harvey
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Janet K. Sluggett
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and SafetyMonash UniversityParkvilleVictoriaAustralia
| | - Monica Cations
- College of Education, Psychology and Social WorkFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tiffany K. Gill
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Faculty of Health and Medical Sciences, Adelaide Medical SchoolThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Jyoti Khadka
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Gillian E. Caughey
- Registry of Senior Australians (ROSA)South Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- UniSA Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
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23
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Carpenter L, Shoubridge AP, Flynn E, Lang C, Taylor SL, Papanicolas LE, Collins J, Gordon D, Lynn DJ, Crotty M, Whitehead C, Leong LEX, Wesselingh SL, Ivey K, Inacio MC, Rogers GB. Cohort profile: GRACE - a residential aged care cohort examining factors influencing antimicrobial resistance carriage. BMC Geriatr 2023; 23:521. [PMID: 37641010 PMCID: PMC10464000 DOI: 10.1186/s12877-023-04215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The emergence of antimicrobial-resistant bacteria represents a considerable threat to human health, particularly for vulnerable populations such as those living in residential aged care. However, antimicrobial resistance carriage and modes of transmission remain incompletely understood. The Generating evidence on antimicrobial Resistance in the Aged Care Environment (GRACE) study was established to determine principal risk factors of antimicrobial resistance carriage and transmission in residential aged care facilities (RACFs). This article describes the cohort characteristics, national representation, and planned analyses for this study. METHODS Between March 2019 and March 2020, 279 participants were recruited from five South Australian RACFs. The median age was 88.6 years, the median period in residence was 681 days, and 71.7% were female. A dementia diagnosis was recorded in 54.5% and more than two thirds had moderate to severe cognitive impairment (68.8%). 61% had received at least one course of antibiotics in the 12 months prior to enrolment. RESULTS To investigate the representation of the GRACE cohort to Australians in residential aged care, its characteristics were compared to a subset of the historical cohort of the Registry of Senior Australians (ROSA). This included 142,923 individuals who were permanent residents of RACFs on June 30th, 2017. GRACE and ROSA cohorts were similar in age, sex, and duration of residential care, prevalence of health conditions, and recorded dementia diagnoses. Differences were observed in care requirements and antibiotic exposure (both higher for GRACE participants). GRACE participants had fewer hospital visits compared to the ROSA cohort, and a smaller proportion were prescribed psycholeptic medications. CONCLUSIONS We have assembled a cohort of aged care residents that is representative of the Australian aged care population, and which provides a basis for future analyses. Metagenomic data isolated from participants and built environments will be used to determine microbiome and resistome characteristics of an individual and the facility. Individual and facility risk exposures will be aligned with metagenomic data to identify principal determinants for antimicrobial resistance carriage. Ultimately, this analysis will inform measures aimed at reducing the emergence and spread of antimicrobial resistant pathogens in this high-risk population.
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Affiliation(s)
- Lucy Carpenter
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew P Shoubridge
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Erin Flynn
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Steven L Taylor
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Lito E Papanicolas
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- SA Pathology, Adelaide, SA, Australia
| | - Josephine Collins
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
| | - David Gordon
- SA Pathology, Adelaide, SA, Australia
- Department of Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, SA, Australia
| | - David J Lynn
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Computational & Systems Biology Programme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Steve L Wesselingh
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kerry Ivey
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Geraint B Rogers
- Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Manuel K, Block H, Crotty M, Harvey G, Kurrle SE, Cameron I, Lockwood K, Sherrington C, Pond D, Nguyen TA, Laver K. Implementation of a frailty intervention in the transition from hospital to home: a realist process evaluation protocol for the FORTRESS trial. BMJ Open 2023; 13:e070267. [PMID: 37295839 PMCID: PMC10277088 DOI: 10.1136/bmjopen-2022-070267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/30/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (the FORTRESS study) is a multisite, hybrid type II, stepped wedge, cluster, randomised trial examining the uptake and outcomes of a frailty intervention. The intervention is based on the 2017 Asia Pacific Clinical Practice Guidelines for the Management of Frailty and begins in the acute hospital setting and transitions to the community. The success of the intervention will require individual and organisational behaviour change within a dynamic health system. This process evaluation will examine the multiple variables at play in the context and mechanism of the frailty intervention to enhance understanding of the outcomes of the FORTRESS study and how the outcomes can be translated from the trial into broader practice. METHODS AND ANALYSIS The FORTRESS intervention will recruit participants from six wards in New South Wales and South Australia, Australia. Participants of the process evaluation will include trial investigators, ward-based clinicians, FORTRESS implementation clinicians, general practitioners and FORTRESS participants. The process evaluation has been designed using realist methodology and will occur in parallel to the FORTRESS trial. A mixed-method approach will be used with qualitative and quantitative data collected from interviews, questionnaires, checklists and outcome assessments. Qualitative and quantitative data will be examined for CMOCs (Context, Mechanism, Outcome Configurations) and programme theories will be developed, tested and refined. This will facilitate development of more generalisable theories to inform translation of frailty intervention within complex healthcare systems. ETHICS AND DISSEMINATION Ethical approval for the FORTRESS trial, inclusive of the process evaluation, has been obtained from the Northern Sydney Local Health District Human Research Ethics Committees reference number 2020/ETH01057. Recruitment for the FORTRESS trial uses opt-out consent. Dissemination will be via publications, conferences and social media. TRIAL REGISTRATION NUMBER ACTRN12620000760976p (FORTRESS trial).
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Affiliation(s)
- Kisani Manuel
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Heather Block
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimity Pond
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
| | - Tuan A Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Victoria, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Kate Laver
- Flinders Health and Medical Research Institute, Adelaide, South Australia, Australia
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Pinheiro MB, Hassett L, Sherrington C, Hayes A, van den Berg M, Lindley RI, Crotty M, Chagpar S, Treacy D, Weber H, Fairhall N, Wong S, McCluskey A, Togher L, Scrivener K, Howard K. Economic evaluation of digitally enabled aged and neurological rehabilitation care in the Activity and MObility UsiNg Technology (AMOUNT) trial. Clin Rehabil 2023; 37:651-666. [PMID: 36408722 DOI: 10.1177/02692155221138920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the trial-based cost-effectiveness of the addition of a tailored digitally enabled exercise intervention to usual care shown to be clinically effective in improving mobility in the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial compared to usual care alone. DESIGN Economic evaluation alongside a pragmatic randomized controlled trial. PARTICIPANTS 300 people receiving inpatient aged and neurological rehabilitation were randomized to the intervention (n = 149) or usual care control group (n = 151). MAIN MEASURES Incremental cost effectiveness ratios were calculated for the additional costs per additional person demonstrating a meaningful improvement in mobility (3-point in Short Physical Performance Battery) and quality-adjusted life years gained at 6 months (primary analysis). The joint probability distribution of costs and outcomes was examined using bootstrapping. RESULTS The mean cost saving for the intervention group at 6 months was AU$2286 (95% Bootstrapped cost CI: -$11,190 to $6410) per participant; 68% and 67% of bootstraps showed the intervention to be dominant (i.e. more effective and cost saving) for mobility and quality-adjusted life years, respectively. The probability of the intervention being cost-effective considering a willingness to pay threshold of AU$50,000 per additional person with a meaningful improvement in mobility or quality-adjusted life year gained was 93% and 77%, respectively. CONCLUSIONS The AMOUNT intervention had a high probability of being cost-effective if decision makers are willing to pay AU$50,000 per meaningful improvement in mobility or per quality-adjusted life year gained, and a moderate probability of being cost-saving and effective considering both outcomes at 6 months post randomization.
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Affiliation(s)
- Marina B Pinheiro
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Leanne Hassett
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maayken van den Berg
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Richard I Lindley
- Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sakina Chagpar
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Daniel Treacy
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Physiotherapy Department, Prince of Wales Hospital, 2989South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Heather Weber
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Fairhall
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Siobhan Wong
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Leanne Togher
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- StrokeEd Collaboration, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, 7788Macquarie University, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Xie E, Pellegrini M, Chen Z, Jolliffe L, Crotty M, Ratcliffe J, Morarty J, O'Brien T, Lannin NA. The influence of substance use on traumatic brain injury recovery and rehabilitation outcomes: The Outcome-ABI Study. Arch Phys Med Rehabil 2023:S0003-9993(23)00184-3. [PMID: 37024005 DOI: 10.1016/j.apmr.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE This study characterised substance-use (alcohol, illicit drugs, amphetamine) in traumatic brain injury (TBI) patients receiving rehabilitation to determine potential benefit of rehabilitation and whether substance-use influenced outcomes in moderate-severe TBI. DESIGN Prospective, longitudinal study of adults with moderate or severe TBI receiving inpatient rehabilitation. SETTING Specialist acquired brain injury rehabilitation centre in Melbourne, Australia. PARTICIPANTS 153 consecutive TBI inpatients admitted between January 2016-December 2017 (24-months). INTERVENTIONS All TBI inpatients (n=153) received specialist brain injury rehabilitation in accordance with evidence-based guideline care at one, 42-bed rehabilitation centre. MAIN OUTCOME MEASURES Data were collected at time of TBI, upon rehabilitation admission and discharge and 12-months post-TBI. Recovery was measured by post-traumatic amnesia (PTA) length-days and change in Glasgow coma scale (admission-discharge). Functional independence was measured on the Functional Independence Measure, Functional Assessment Measure and Mayo Portland Adaptability Index (MPAI). Quality of life (QOL) was measured on the EuroQOL-5D-5L (EQ-5D-5L) and quality of life after brain injury (QOLIBRI) instruments. RESULTS Inpatients with history of illicit drug-use (n=54) reported lower QOL and adjustment at 12-months post-TBI compared to those with no-history (QOLIBRI social relationships: Ratio of Means (RoM)=0.808, p=0.028; MPAI-adjustment: IRR=1.273, p=0.032). Amphetamine-use at time of injury (n=10) was associated with quicker recovery (PTA length-days: IRR=0.173, p<0.01), however lower QOL at 12-months post-TBI was noted in those with a history of amphetamine-use (n=34) compared to those without (QOLIBRI bothered feelings: RoM=0.489, p=0.036). CONCLUSION All participants made improvements with rehabilitation post-TBI, however a history of substance-use was associated with lower reported 12-month QOL. Findings add insight to the associations between substance-use and acute recovery, potentially suggestive of a short-term recovery-promoting effect of amphetamine but highlighting the importance of rehabilitation to address long-term sequalae.
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Affiliation(s)
- Eric Xie
- Department of Neurology, Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004
| | - Michael Pellegrini
- Department of Neuroscience, Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004
| | - Laura Jolliffe
- Frankston Hospital, Peninsula Health, 2 Hastings Rd, Frankston, VIC, 3199; Peninsula Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, 3199; Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, VIC, 3199
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Flinders University, Daw Park, SA, 5041
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Bedford Park, SA, 5042
| | - Jacqui Morarty
- Rehabilitation Services, Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004
| | - Terence O'Brien
- Department of Neurology, Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004; Department of Neuroscience, Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004; Department of Medicine and Neurology, The Royal Melbourne Hospital, Melbourne Health, 300 Grattan St, Parkville, VIC, 3050
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004; Rehabilitation Services, Alfred Health, 55 Commercial Rd, Melbourne, VIC, 3004.
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Eshetie TC, Moldovan M, Caughey GE, Lang C, Sluggett JK, Khadka J, Whitehead C, Crotty M, Corlis M, Visvanathan R, Wesselingh S, Inacio MC. Development of a Multivariable Prediction Model for Risk of Hospitalization With Pressure Injury After Entering Residential Aged Care. J Am Med Dir Assoc 2023; 24:299-306.e9. [PMID: 36603825 DOI: 10.1016/j.jamda.2022.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/05/2022] [Accepted: 12/03/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data. DESIGN National retrospective cohort study. SETTING AND PARTICIPANTS Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016. METHODS PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care-related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample. RESULTS Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77-3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74-2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44-2.05); and history of skin disease (sHR 1.54; 95% CI 1.45-1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72-0.75). CONCLUSIONS AND IMPLICATIONS Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry.
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Affiliation(s)
- Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia.
| | - Max Moldovan
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Janet K Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Jyoti Khadka
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Megan Corlis
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council, Centre of Research Excellence Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia; Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Nguyen TA, Tran KV, Hinton L, Roughead EE, Esterman A, Dang TH, Kim GB, Pham DB, Nguyen HTD, Crotty M, Kurrle S, Pham T, Pham TL, Hoang P, Brodaty H. Experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora: a systematic review of qualitative studies. Aging Ment Health 2023; 27:301-316. [PMID: 35549573 DOI: 10.1080/13607863.2022.2056136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: This paper aimed to review and synthesise the qualitative research evidence on the experiences and perceptions of dementia in Vietnam and among the Vietnamese diaspora.Methods: Systematic searches were conducted in June 2019 using Medline, Embase, Emcare, PsycINFO and Cochrane electronic databases, as well as grey literature. Keywords and Medical Subject Headings [MeSH terms] for dementia and associated terms were combined with keywords for Vietnam and its provinces. Qualitative research articles published in English or Vietnamese were included to examine evidence on the life experiences of Vietnamese people with dementia using thematic analysis.Results: Our searches resulted in 3,940 papers, from which 21 qualitative research studies were included for final analysis. The majority of research has not been undertaken in Vietnam but with the Vietnamese diaspora in Western countries and has taken a cultural perspective to analyses. Research in Western countries has focused on the need for culturally adapted and culturally sensitive models of care. Emerging themes about the life experiences of Vietnamese people with dementia identified from the studies included: many people do not have diagnostic terms for dementia but use the descriptive language of symptoms; stigma was a reported problem and on occasions can be observed in the descriptive language used for people with dementia; cultural and traditional values create both an opportunity and a barrier, supporting compassion, family care and relaxation, but creating barriers to accessing health services or long-term residential care.Conclusions: This is the first systematic review reporting qualitative evidence on the life experiences of people with dementia in Vietnam and among the Vietnamese diaspora. Future research is needed on the voice of people with dementia themselves and their caregivers particularly in Vietnam, and low and middle-income countries with regards to living with dementia, pathways to care from diagnosis, treatment, care and support, additional social care and preparedness for end of life care for people with dementia.
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Affiliation(s)
- Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Kham Van Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Elizabeth E Roughead
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Esterman
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Thu Ha Dang
- Social Gerontology Division, National Ageing Research Institute, Melbourne, VIC, Australia.,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Giang Bao Kim
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Diep Bich Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Diem Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Maria Crotty
- College of Medicine and Public Health, Rehabilitation, Aged & Extended Care, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Thang Pham
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | - Tuan Le Pham
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Phuong Hoang
- UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, The University of New South Wales, Sydney, NSW, Australia
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Sluggett JK, Air T, Cations M, Caughey GE, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. Clinical Quality Indicators for Monitoring Hospitalizations Among Older People with Dementia Accessing Aged Care Services. J Alzheimers Dis 2023; 96:1747-1758. [PMID: 38007661 DOI: 10.3233/jad-230730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer's disease and other forms of dementia. OBJECTIVE To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia accessing aged care services and determine 1) annual trends in CQI incidence between 2011-2012 and 2015-2016, 2) associated factors, and 3) geographic and facility variation in CQI incidence. METHODS This retrospective repeated cross-sectional study included non-Indigenous individuals aged 65-105 years who lived with dementia between July 2008-June 2016, were assessed for government-funded aged care services, and resided in New South Wales or Victoria (n = 180,675). Poisson or negative binomial regression models estimated trends in annual CQI incidence and associated factors. Funnel plots examined CQI variation. RESULTS Between 2011-2012 and 2015-2016, CQI incidence increased for falls (11.0% to 13.9%, adjusted incidence rate ratio (aIRR) 1.05 (95% CI 1.01-1.06)) and delirium (4.7% to 6.7%, aIRR 1.09 (95% CI 1.07-1.10)), decreased for unplanned hospitalizations (28.7% to 27.9%, aIRR 0.99 (95% CI 0.98-0.99)) and remained steady for fracture (6.2% to 6.5%, aIRR 1.01 (95% CI 0.99-1.01)) and pressure injuries (0.5% to 0.4%, aIRR 0.99 (95% CI 0.96-1.02)). Being male, older, having more comorbidities and living in a major city were associated with higher CQI incidence. Considerable geographical and facility variation was observed for unplanned hospitalizations and delirium CQIs. CONCLUSIONS The CQI results highlighted considerable morbidity. The CQIs tested should be considered for application in clinical quality registries to monitor dementia care quality.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Shafei I, Karnon J, Crotty M. Quality Improvement in Stroke Rehabilitation: A Scoping Review. J Multidiscip Healthc 2022; 15:2913-2931. [PMID: 36578360 PMCID: PMC9791932 DOI: 10.2147/jmdh.s389567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Quality improvement interventions are used extensively in health care, aiming to improve delivery and promote best practice. The impact of quality improvement interventions implemented in stroke rehabilitation remains unclear. Objective The aim of this scoping review is to examine the different types of published quality improvement interventions in stroke rehabilitation and their impact on improving the quality of care. Materials and Methods A scoping review was performed in the PubMed, Embase and CINAHL databases. QI studies evaluating interventions for stroke rehabilitation patients that were published up to August 2020 were included. The review looked at the types of quality improvement interventions that have been evaluated as well as the improvements/impacts reported for quality improvement interventions for stroke patients in rehabilitation. Results We reviewed 1580 studies, twelve quality improvement interventions met inclusion criteria and were included in the current study. Six studies involved organizational change, three studies involved provider education and audit-feedback and three studies involved provider education. Of the twelve quality improvement interventions that have been included, >90% reported improvements (91.6%). In the majority of cases, improvements were noted through implementation of a myriad of interventions. Several facilitators and barriers were noted during implementation and contributed to success or failure of the intervention. Conclusion There is paucity of full-text peer-reviewed published research investigating quality improvement interventions for improving the quality of care in stroke rehabilitation. The current review offers value to healthcare providers in terms of key success factors, contextual factors, barriers and facilitators associated with improvements in stroke rehabilitation.
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Affiliation(s)
- Ingy Shafei
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia,College of Business, Government and Law, Flinders University, Adelaide, South Australia, Australia,Correspondence: Ingy Shafei, Faculty of Health and Medical Sciences, The University of Adelaide, GPO Box 2100, Adelaide, South Australia, 5001, Australia, Tel +61 0458715670, Email
| | - Jonathan Karnon
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Brass A, Shoubridge AP, Larby N, Elms L, Sims SK, Flynn E, Miller C, Crotty M, Papanicolas LE, Wesselingh SL, Morawska L, Bell SC, Taylor SL, Rogers GB. Targeted reduction of airborne viral transmission risk in long-term residential aged care. Age Ageing 2022; 51:6964928. [PMID: 36580555 DOI: 10.1093/ageing/afac316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Indexed: 12/31/2022] Open
Abstract
COVID-19 has demonstrated the devastating consequences of the rapid spread of an airborne virus in residential aged care. We report the use of CO2-based ventilation assessment to empirically identify potential 'super-spreader' zones within an aged care facility, and determine the efficacy of rapidly implemented, inexpensive, risk reduction measures.
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Affiliation(s)
- Amanda Brass
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Andrew P Shoubridge
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nicolas Larby
- Aged Care Property Services Management, Adelaide, SA, Australia
| | - Levi Elms
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sarah K Sims
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Erin Flynn
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,National Centre for Epidemiology & Population Health, The Australian National University, Canberra, ACT, Australia
| | - Caroline Miller
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Maria Crotty
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Lito E Papanicolas
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,SA Pathology, SA Health, Adelaide, SA, Australia
| | - Steve L Wesselingh
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Scott C Bell
- The Prince Charles Hospital, Brisbane, QLD, Australia.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Steven L Taylor
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Geraint B Rogers
- The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Stevens D, Barr C, Bassett K, Oh A, Lord SR, Crotty M, Bickley K, Mukherjee S, Vakulin A. Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years. Sleep Med 2022; 100:448-453. [PMID: 36252413 DOI: 10.1016/j.sleep.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA. DESIGN Single arm intervention study. SETTING University and tertiary care CPAP clinic. PARTICIPANTS Individuals over 65 years diagnosed with OSA and recommended CPAP. INTERVENTION 3-6 months CPAP therapy. MEASUREMENTS 28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS. RESULTS CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (β = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015). CONCLUSIONS CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.
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Affiliation(s)
- David Stevens
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Centre for Nutritional and Gastrointestinal Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chris Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Bassett
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Aaron Oh
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, and Faculty of Medicine, University of New South Wales, Sydney, N.S.W, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Rahja M, Laver K, Whitehead C, Pietsch A, Oliver E, Crotty M. A systematic review and meta-analysis of reablement interventions for people in permanent residential aged care homes. Age Ageing 2022; 51:6754360. [PMID: 36215172 DOI: 10.1093/ageing/afac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Most evidence for reablement comes from community-based interventions. OBJECTIVE To determine the effect of reablement interventions provided in permanent residential aged care (PRAC) homes on residents' level of function in activities of daily living (ADL) and quality of life (QoL). DESIGN Systematic review and meta-analysis. SETTING PRAC homes. SUBJECTS Residents in PRAC. METHODS Six databases and grey literature were searched until November 2021. Quantitative studies involving a control group or pre-post evaluation were included. Outcomes of interest were the effectiveness of the reablement intervention on overall ADL or QoL in the last available follow-up. RESULTS Twelve studies involving 2,620 residents were included. The reablement interventions varied; the primary focus areas were organisational approaches (e.g. educating staff; n = 10) and improving physical function (e.g. increasing physical activity; n = 9). Not all studies could be pooled in the meta-analysis due to reported data and heterogeneity. There was no significant effect of reablement intervention versus usual care on ADL function (five studies, standardised mean difference (SMD): 0.17, 95% confidence interval (CI): -0.25 to 0.59, very low quality evidence). Reablement appeared more beneficial than usual care in improving QoL; however, the overall effect was not statistically significant (four studies, SMD: 0.73, 95% CI: -0.07 to 1.52; very low quality evidence). CONCLUSIONS Few studies focus on reablement in PRAC homes and their clinical heterogeneity is considerable. There is insufficient evidence for reablement in terms of improving ADL or QoL for residents in PRAC. Tools that are more sensitive to change may be beneficial.
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Affiliation(s)
- Miia Rahja
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, 5042, South Australia, Australia
| | | | - Eliza Oliver
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, 5042, South Australia, Australia
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, Bedford Park, 5042, South Australia, Australia
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Caughey G, Ryan O, Crotty M, Whitehead C, Hillier S, Evans K, Von Thien M, Mason C, Radbone C, Mussared J, Ratcliffe J, Tideman S, Barker A, Sheppeard A, Miller C, Pearson O, Corlis M, Candy A, Wesselingh S, Inacio M. The Registry of Senior Australians: Informing Aged Care Policy Reforms. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesTo: (1) outline the research produced using linked data from the Registry of Senior Australians (ROSA) which informed the recommendations from Australia’s Royal Commission into Aged Care Quality and Safety (delivered February 2021); (2) describe the Australian Government Aged Care Roadmap Reforms (announced May 2021) resulting from the recommendations.
ApproachROSA was established in 2017 and is led by a partnership of scientists, clinicians, aged care providers and consumer advocates from nine organisations seeking to improve the lives of Australians in aged care. ROSA is a Clinical Quality Registry comprised of linked national and cross-jurisdictional aged and health care data and includes a national historical de-identified cohort (3.5 million individuals, 2002-2020) and a prospectively enrolled cohort in the state of South Australia (26,600 individuals, 2018-current). This is a summary of ROSA’s high-quality evidence used by the Royal Commission and translation of this evidence into policy by leveraging existing data infrastructure.
ResultsBetween 2019-2020 the ROSA team led the delivery of four in-depth reports for the Royal Commission, contributed data and expertise to an additional four published Commission reports. Examples of ROSA outputs informing the Commissions’ recommendations included: evidence of national increased psychotropic medication use following entry to residential aged care, evidence of higher risk of mortality and entry to permanent care while waiting for home care packages, development of quality indicators to monitor quality and safety of care nationally, and to facilitate international comparisons and benchmarking. Examples of recommendations included in the Australian Government Aged Care Roadmap: release of substantial funding to increase the availability of home care packages, public reporting system for quality and safety monitoring and several changes to medication management.
ConclusionRegistries are key resources for high quality real-world evidence generation needed to inform national investigations, ultimately leading to significant sector reform. The ROSA experience highlights that cross-sectoral data linkages, together with technical expertise, informed by clinicians and consumers, are invaluable resources for system reform and policy generation.
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Dyer SM, Suen J, Williams H, Inacio MC, Harvey G, Roder D, Wesselingh S, Kellie A, Crotty M, Caughey GE. Impact of relational continuity of primary care in aged care: a systematic review. BMC Geriatr 2022; 22:579. [PMID: 35836118 PMCID: PMC9281225 DOI: 10.1186/s12877-022-03131-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Greater continuity of care has been associated with lower hospital admissions and patient mortality. This systematic review aims to examine the impact of relational continuity between primary care professionals and older people receiving aged care services, in residential or home care settings, on health care resource use and person-centred outcomes. Methods Systematic review of five databases, four trial registries and three grey literature sources to October 2020. Included studies (a) aimed to increase relational continuity with a primary care professional, (b) focused on older people receiving aged care services (c) included a comparator and (d) reported outcomes of health care resource use, quality of life, activities of daily living, mortality, falls or satisfaction. Cochrane Collaboration or Joanna Briggs Institute criteria were used to assess risk of bias and GRADE criteria to rate confidence in evidence and conclusions. Results Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. None examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces hospital admissions (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.94; 95% confidence interval (CI) 0.92–0.96, n = 178,686; incidence rate ratio (IRR) 0.99, 95%CI 0.76–1.27, n = 246) and emergency department (ED) presentations (moderate certainty evidence; high versus low continuity HR 0.90, 95%CI 0.89–0.92, n = 178,686; IRR 0.91, 95%CI 0.72–1.15, n = 246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care for relational continuity in residential settings is uncertain (low certainty evidence, 2 studies, n = 2,468 plus 15 care homes); whilst there are probably lower hospitalisations and may be fewer ED presentations, there may also be an increase in reported mortality and falls. The benefit of general practitioners’ visits during hospital admission is uncertain (very low certainty evidence, 1 study, n = 335). Conclusion Greater relational continuity with a primary care physician probably reduces hospitalisations and ED presentations for community-dwelling aged care recipients, thus policy initiatives that increase continuity may have cost offsets. Further studies of approaches to increase relational continuity of primary care within aged care, particularly in residential settings, are needed. Review registration CRD42021215698. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03131-2.
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Affiliation(s)
- Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - Jenni Suen
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Rahja M, Air T, Ahern S, Ward SA, Caughey GE, Sluggett JK, Cations M, Lin X, Wallis K, Crotty M, Inacio M. Primary and Secondary Care Related Quality Indicators for Dementia Care Among Australian Aged Care Users: National Trends, Risk Factors, and Variation. J Alzheimers Dis 2022; 88:1511-1522. [DOI: 10.3233/jad-220336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government-subsidized aged care. The examined CQIs were: comprehensive medication reviews, 75+ health assessments, comprehensive geriatric assessments, chronic disease management plans, general practitioner (GP) mental health treatment plans, and psychiatrist attendances. Methods: Retrospective cohort study (2011–2016) of 255,458 individuals. National trend analyses estimated incidence rates and 95% confidence intervals (CI) using Poisson or negative binomial regression. Associations were assessed using backward stepwise multivariate Poisson or negative binomial regression model, as appropriate. Funnel plots examined geographic and PRAC facility variation. Results: CQI incidence increased in all CQIs but medication reviews. For the overall cohort, 75+ health assessments increased from 1.07/1000 person-days to 1.16/1000 person-days (adjusted incidence rate ratio (aIRR) = 1.03, 95% CI 1.02–1.03).Comprehensive geriatric assessments increased from 0.24 to 0.37/1000 person-days (aIRR = 1.12, 95% CI 1.10–1.14). GP mental health treatment plans increased from 1.30 to 2.1/1000 person-days (aIRR = 1.13, 95% CI 1.12–1.15). Psychiatric attendances increased from 0.09 to 0.11/1000 person-days (aIRR = 1.05, 95% CI 1.03–1.07). Being female, older, having fewer comorbidities, and living outside a major city were associated with lower likelihood of using the services. Large geographical and facility variation was observed (0–92%). Conclusion: Better use of primary and secondary care services to address needs of individuals with dementia is urgently needed.
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Affiliation(s)
- Miia Rahja
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Stephanie A. Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Gillian E. Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Janet K. Sluggett
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, SA, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, Australia
| | - Xiaoping Lin
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Kasey Wallis
- Department of Epidemiology and Preventive Medicine, Monash University, Parkville, VIC, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Maria Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Cations M, Collier LR, Caughey G, Bartholomaeus J, Lang C, Crotty M, Harvey G, Wesselingh S, Corlis M, Inacio MC. Government-subsidised mental health services are underused in Australian residential aged care facilities. AUST HEALTH REV 2022; 46:432-441. [PMID: 35772928 DOI: 10.1071/ah22049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities.MethodsA retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services.ResultsThe use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services.ConclusionsLess than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.
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Affiliation(s)
- Monica Cations
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Luke R Collier
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Gillian Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jonathan Bartholomaeus
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Steven Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia
| | - Megan Corlis
- Aged Care and Research, Australian Nursing and Midwifery Foundation, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute Adelaide, SA 5001, Australia; and Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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Block H, Annesley A, Lockwood K, Xu L, Cameron ID, Laver K, Crotty M, Sherrington C, Kifley A, Howard K, Pond D, Nguyen TA, Kurrle SE. Frailty in older people: Rehabilitation Treatment Research Examining Separate Settings (FORTRESS): protocol for a hybrid type II stepped wedge, cluster, randomised trial. BMC Geriatr 2022; 22:527. [PMID: 35761212 PMCID: PMC9235164 DOI: 10.1186/s12877-022-03178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Frailty in older people is associated with increased risk of falls, longer length of stay in hospital, increased risk of institutionalisation and death. Frailty can be measured using validated tools. Multi-component frailty interventions are recommended in clinical practice guidelines but are not routinely implemented in clinical practice. Methods The Frailty in Older people: Rehabilitation, Treatment, Research Examining Separate Settings (FORTRESS) trial is a multisite, hybrid type II, stepped wedge, cluster, randomised trial with blinded assessment and intention-to-treat analysis being conducted in Australia. The study aims to determine the effectiveness and cost-effectiveness of an embedded individualised multicomponent frailty intervention (commencing in hospital and continuing in the community) on readmissions, frailty and quality of life when compared with usual care. Frail older people admitted to study wards with no significant cognitive impairment, who are expected to return home after discharge, will be eligible to participate. Participants will receive extra sessions of physiotherapy, pharmacy, and dietetics during their admission. A Community Implementation Facilitator will coordinate implementation of the frailty management strategies and primary network liaison. The primary outcome is number of days of non-elective hospital readmissions during 12 month follow-up period. Secondary outcomes include frailty status measured using the FRAIL scale; quality of life measured using the EQ-5D-5L; and time-to-event for readmission and readmission rates. The total cost of delivering the intervention will be assessed, and cost-effectiveness analyses will be conducted. Economic evaluation will include analyses for health outcomes measured in terms of the main clinical outcomes. Implementation outcomes will be collected as part of a process evaluation. Recruitment commenced in 2020 and we are aiming to recruit 732 participants over the three-year duration of the study. Discussion This study will reveal whether intervening with frail older people to address factors contributing to frailty can reduce hospital readmissions and improve frailty status and quality of life. If the FORTRESS intervention provides a clinically significant and cost-effective result, it will demonstrate an improved approach to treating frail patients, both in hospital and when they return home. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000760976p. ANZCTR registered 24 July 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03178-1.
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Rupa J, Laver K, Harvey G, McNamara C, Crotty M, Lynch EA. A 'plethora of services' but a lack of consistency: A qualitative study of service providers' perspectives about transitioning from hospital to home for older South Australians. Australas J Ageing 2022; 41:e371-e378. [PMID: 35502850 DOI: 10.1111/ajag.13080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We explored the perspectives of professionals working in health and aged care services in South Australia about factors that influenced successful transitions from hospital to home or residential aged care home for older people. We examined successful and recommended strategies that could support safe transitions following hospital discharge and reduce avoidable hospital admissions in South Australia. METHODS Nineteen professionals from acute, post-acute, primary, community and aged care settings in South Australia participated in semi-structured interviews. Qualitative content analysis was conducted. RESULTS Participants reported that navigating service provision could be difficult, compounded by different funding arrangements for hospitals, community, primary care and aged care services. Some participants felt that there was an over-reliance on the hospital sector, leaving primary care and community-based services under-utilised to support hospital transitions. The importance of good communication between services and sectors was highlighted. Participants described different categories of services that supported safe transitions by supporting older people immediately post-discharge; services that provided support to stay at home in the weeks and months following discharge; and services that helped the person receive health care at locations other than hospitals or emergency departments when they were unwell. Participants noted that successful programs were not always maintained. CONCLUSIONS Division of responsibility of aged and health-care services between state and national governance contributes to fragmentation of care in South Australia. Careful planning of transitions and coordination of services across sectors is required to ensure older people are supported in the months following discharge from hospital to reduce avoidable rehospitalisations.
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Affiliation(s)
- Jesmin Rupa
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Carmel McNamara
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Lannin NA, Ada L, English C, Ratcliffe J, Faux S, Palit M, Gonzalez S, Olver J, Schneider E, Crotty M, Cameron ID. Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial. BMC Neurol 2022; 22:154. [PMID: 35468766 PMCID: PMC9036685 DOI: 10.1186/s12883-022-02672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies. AIM To determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke. METHOD An analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. RESULTS By 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome. CONCLUSION Additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term. TRIAL REGISTRATION ACTRN12615000616572 (12/06/2015).
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Affiliation(s)
- Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia. .,Alfred Health, Melbourne, Australia. .,School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia.
| | - Louise Ada
- The University of Sydney, Sydney, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Steven Faux
- Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - John Olver
- Epworth Monash Rehabilitation Medicine Research Unit, Monash University, Melbourne, Australia
| | - Emma Schneider
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Maria Crotty
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Rehabilitation and Aged Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
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Laver K, Lynch E, Rupa J, Mcnamara C, Crotty M, Harvey G. Establishing and evaluating a quality improvement collaborative to address hospital to home transitions for older people. BMJ Open Qual 2022; 11:bmjoq-2021-001774. [PMID: 35273000 PMCID: PMC8915304 DOI: 10.1136/bmjoq-2021-001774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/21/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Hospital use increases with age. Older people and their families have reported poor experiences of care at the time of discharge home from hospital. As part of a larger project, we established and evaluated a quality improvement collaborative to address hospital to home transitions for older people. Methods We convened an expert panel of 34 stakeholders to identify modifiable issues in the hospital-home transition period. We established a collaborative involving health professionals across a range of agencies working to common goals. Teams were supported by a network manager, three learning sessions and quality improvement methodology to address their identified area for improvement. We used mixed methods to evaluate whether the establishment of the quality improvement collaborative built networks, built capacity in the health professionals and improved the quality of care for older people. Evaluation methods included interviews, surveys, network mapping and case studies. Results Nine teams (n=41 participants) formed the collaborative and attended all meetings. Mapping showed an increase in networks between participants and organisations at the conclusion of the collaborative. Interview data showed that building relationships across services was one of the most important parts of the collaborative. Survey results revealed that most (77%) believed their quality improvement skills had developed through participation. Advice and regular meetings to progress project work were considered important in ensuring teams stayed focused. In terms of improving the quality of care, some participants indicated that they achieved the stated aims of their project better than expected (21%), most (41%) felt they achieved their aim as expected, 26% got close to their aim and the rest did not know the outcome (13%). Conclusions Establishing a quality improvement collaborative was a positive activity in terms of building a network across organisations and progressing quality improvement projects which aimed to achieve the same overall goal.
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Affiliation(s)
- Kate Laver
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Jesmin Rupa
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Carmel Mcnamara
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Harrison SL, Dyer SM, Laver KE, Milte RK, Fleming R, Crotty M. Physical environmental designs in residential care to improve quality of life of older people. Cochrane Database Syst Rev 2022; 3:CD012892. [PMID: 35253911 PMCID: PMC8900466 DOI: 10.1002/14651858.cd012892.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The demand for residential aged care is increasing due to the ageing population. Optimising the design or adapting the physical environment of residential aged care facilities has the potential to influence quality of life, mood and function. OBJECTIVES To assess the effects of changes to the physical environment, which include alternative models of residential aged care such as a 'home-like' model of care (where residents live in small living units) on quality of life, behaviour, mood and depression and function in older people living in residential aged care. SEARCH METHODS CENTRAL, MEDLINE, Embase, six other databases and two trial registries were searched on 11 February 2021. Reference lists and grey literature sources were also searched. SELECTION CRITERIA Non-randomised trials, repeated measures or interrupted time series studies and controlled before-after studies with a comparison group were included. Interventions which had modified the physical design of a care home or built a care home with an alternative model of residential aged care (including design alterations) in order to enhance the environment to promote independence and well-being were included. Studies which examined quality of life or outcomes related to quality of life were included. Two reviewers independently assessed the abstracts identified in the search and the full texts of all retrieved studies. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data, assessed the risk of bias in each included study and evaluated the certainty of evidence according to GRADE criteria. Where possible, data were represented in forest plots and pooled. MAIN RESULTS Twenty studies were included with 77,265 participants, although one large study included the majority of participants (n = 74,449). The main comparison was home-like models of care incorporating changes to the scale of the building which limit the capacity of the living units to smaller numbers of residents and encourage the participation of residents with domestic activities and a person-centred care approach, compared to traditional designs which may include larger-scale buildings with a larger number of residents, hospital-like features such as nurses' stations, traditional hierarchical organisational structures and design which prioritises safety. Six controlled before-after studies compared the home-like model and the traditional environment (75,074 participants), but one controlled before-after study included 74,449 of the participants (estimated on weighting). It is uncertain whether home-like models improve health-related quality of life, behaviour, mood and depression, function or serious adverse effects compared to traditional designs because the certainty of the evidence is very low. The certainty of the evidence was downgraded from low-certainty to very low-certainty for all outcomes due to very serious concerns due to risk of bias, and also serious concerns due to imprecision for outcomes with more than 400 participants. One controlled before-after study examined the effect of home-like models on quality of life. The author stated "No statistically significant differences were observed between the intervention and control groups." Three studies reported on global behaviour (N = 257). One study found little or no difference in global behaviour change at six months using the Neuropsychiatric Inventory where lower scores indicate fewer behavioural symptoms (mean difference (MD) -0.04 (95% confidence interval (CI) -0.13 to 0.04, n = 164)), and two additional studies (N = 93) examined global behaviour, but these were unsuitable for determining a summary effect estimate. Two controlled before-after studies examined the effect of home-like models of care compared to traditional design on depression. After 18 months, one study (n = 242) reported an increase in the rate of depressive symptoms (rate ratio 1.15 (95% CI 1.02 to 1.29)), but the effect of home-like models of care on the probability of no depressive symptoms was uncertain (odds ratio 0.36 (95% CI 0.12 to 1.07)). One study (n = 164) reported little or no difference in depressive symptoms at six months using the Revised Memory and Behaviour Problems Checklist where lower scores indicate fewer depressive symptoms (MD 0.01 (95% CI -0.12 to 0.14)). Four controlled before-after studies examined function. One study (n = 242) reported little or no difference in function over 18 months using the Activities of Daily Living long-form scale where lower scores indicate better function (MD -0.09 (95% CI -0.46 to 0.28)), and one study (n = 164) reported better function scores at six months using the Interview for the Deterioration of Daily Living activities in Dementia where lower scores indicate better function (MD -4.37 (95% CI -7.06 to -1.69)). Two additional studies measured function but could not be included in the quantitative analysis. One study examined serious adverse effects (physical restraints), and reported a slight reduction in the important outcome of physical restraint use in a home-like model of care compared to a traditional design (MD between the home-like model of care and traditional design -0.3% (95% CI -0.5% to -0.1%), estimate weighted n = 74,449 participants at enrolment). The remaining studies examined smaller design interventions including refurbishment without changes to the scale of the building, special care units for people with dementia, group living corridors compared to a non-corridor design, lighting interventions, dining area redesign and a garden vignette. AUTHORS' CONCLUSIONS There is currently insufficient evidence on which to draw conclusions about the impact of physical environment design changes for older people living in residential aged care. Outcomes directly associated with the design of the built environment in a supported setting are difficult to isolate from other influences such as health changes of the residents, changes to care practices over time or different staff providing care across shifts. Cluster-randomised trials may be feasible for studies of refurbishment or specific design components within residential aged care. Studies which use a non-randomised design or cluster-randomised trials should consider approaches to reduce risk of bias to improve the certainty of evidence.
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Affiliation(s)
- Stephanie L Harrison
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kate E Laver
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rachel K Milte
- Caring futures institute, Flinders University, Adelaide, Australia
| | - Richard Fleming
- School of Science Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Milte RK, Mpundu-Kaambwa C, Chen G, Crotty M, Ratcliffe J. What Constitutes Preferred Long-Term Care Provided in Residential Aged Care Facilities? An Empirical Comparison of the Preferences of the General Population, Residents, and Family Members. Value Health 2022; 25:257-267. [PMID: 35094799 DOI: 10.1016/j.jval.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/28/2021] [Accepted: 09/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Relatively few studies to date have examined the preferences of members of the general population as potential future consumers of long-term aged care services. This study aimed to use discrete choice experiment methodology to compare the preferences of 3 groups: the general population, residents, and family members of people living in long-term aged care. METHODS A total of 6 salient attributes describing the physical and psychosocial care in long-term residential aged care were drawn from qualitative research with people with a lived experience of aged care and were used to develop the discrete choice experiment questionnaire. The 6 attributes included: the level of time care staff spent with residents, homeliness of shared spaces, the homeliness of their own rooms, access to outside and gardens, frequency of meaningful activities, and flexibility with care routines. The questionnaire was administered to 1243 respondents including consumers (residents [n = 126], family member carers [n = 416]), and members of the general population (n = 701). RESULTS For both the general population and resident samples, having their own room feeling "home-like" exhibited the largest impact upon overall preferences. For the family member sample, care staff being able to spend enough time exhibited the largest impact. Tests of poolability indicated that the resident and general population samples estimates could be pooled. The null hypothesis of equal parameters between the groups was rejected for the family members, indicating significant differences in preferences relative to the resident and the general population samples. CONCLUSIONS This study illustrates that preferences for residential aged care delivery may vary depending upon perspective and experience.
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Affiliation(s)
- Rachel K Milte
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, Department of Rehabilitation and Aged Care, University of Sydney, Sydney, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia.
| | | | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Maria Crotty
- Cognitive Decline Partnership Centre, Department of Rehabilitation and Aged Care, University of Sydney, Sydney, Australia; Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Mulder M, Nijland RHM, Vloothuis JDM, van den Berg M, Crotty M, Kwakkel G, van Wegen EEH. Comparing two identically protocolized, multicentre, randomized controlled trials on caregiver-mediated exercises poststroke: Any differences across countries? PLoS One 2022; 17:e0263013. [PMID: 35077507 PMCID: PMC8789096 DOI: 10.1371/journal.pone.0263013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background The evidence for rehabilitation interventions poststroke lack sufficient robustness. However, variation in treatment effects across countries have been given little attention. Objective To compare two identically protocolized trials conducted in different western countries in order to identify factors that may have caused variation in secondary trial outcomes. Methods Comparative study based on individual patient data (N = 129) from two randomized controlled trials, conducted in hospitals and rehabilitation facilities in the Netherlands (N = 66) and Australia (N = 63). Patients with stroke and their caregivers were randomly allocated to an 8-week caregiver-mediated exercises intervention (N = 63; 31 Australian and 32 Dutch) or to a control group (N = 66; 32 Australian and 34 Dutch). Patient characteristics, compliance, usual care and process measures were compared across countries. We examined if study setting significantly moderated the trial outcomes: Hospital Anxiety and Depression Scale, Fatigue Severity Scale and General Self-Efficacy Scale, measured at 8- and 12 weeks follow-up. In addition, we explored if factors that were significantly different across countries caused variation in these trial outcomes. Results Most patients suffered an ischemic stroke, were in the subacute phase and participated with their partner. Dutch patients were younger (P = 0.005) and had a lower functional status (P = 0.001). Australian patients were recruited earlier poststroke (P<0.001), spent less time in exercise therapy (P<0.001) and had a shorter length of stay (P<0.001). The level of contamination was higher (P = 0.040) among Dutch controls. No effect modification was observed and trial outcomes did not change after controlling for cross-country differences. Conclusions The present study highlighted important clinical differences across countries whilst using an identical study protocol. The observed differences could result in a different potential for recovery and variation in treatment effects across trials. We argue that we can proceed faster to evaluating interventions within international pragmatic trials.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | | | | | - Maayken van den Berg
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
| | - Erwin E. H. van Wegen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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Jorissen RN, Crotty M, Caughey GE, Harvey G, Inacio MC. Hospitalizations Before and After Entry Into Long-Term Care. J Am Med Dir Assoc 2022; 23:1429-1430. [PMID: 35032455 DOI: 10.1016/j.jamda.2021.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; SA Health, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia; Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, Australia
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Oberai T, Woodman R, Laver K, Crotty M, Kerkhoffs G, Jaarsma R. Is delirium associated with negative outcomes in older patients with hip fracture: analysis of the 4904 patients 2017-2018 from the Australian and New Zealand hip fracture registry. ANZ J Surg 2021; 92:200-205. [PMID: 34904334 DOI: 10.1111/ans.17421] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
AIM To determine associations between delirium and health outcomes using the Australia and New Zealand population-based hip fracture patient registry (ANZHFR). METHODS We performed a retrospective cohort study using data from the ANZHFR among hip-fracture surgery patients admitted to and discharged from hospital between 1 January 2017 and 31 December 2018. RESULTS Of the 4904 patients with complete data and included in the analysis, 1789 (36.5%) experienced delirium during their hospital stay. Patients with delirium also had a higher rate of in-hospital mortality (adjusted HR = 1.76; 95% CI = 1.24, 2.49; P < 0.001), a higher rate of long-term mortality (adjusted HR = 1.30; 95% CI = 1.15, 1.48; P < 0.001) and a higher odds of discharge to an aged care facility (adjusted OR = 1.24; 95% CI = 1.04, 1.48; P = 0.019). CONCLUSION A high rate of postoperative delirium exists among Australian and New Zealand hip fracture patients. Rates of hospital mortality, length of hospital stay and discharge to residential aged care are considerably worse in these patients.
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Affiliation(s)
- Tarandeep Oberai
- Department of Orthopedic and Trauma Surgery, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Richard Woodman
- Department of Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Aged Care, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Aged Care, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Gino Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruurd Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
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Nguyen TA, Tran K, Hinton L, Roughead EE, Esterman A, Dang TH, Kim GB, Pham DB, Nguyen HTD, Crotty M, Kurrle S, Pham T, Le Pham T, Brodaty H. Life experiences of people with dementia in Vietnam and among the Vietnamese diaspora: A systematic review of qualitative studies. Alzheimers Dement 2021. [DOI: 10.1002/alz.054820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tuan Anh Nguyen
- University of South Australia Adelaide SA Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
| | - Kham Tran
- University of South Australia Adelaide SA Australia
| | - Ladson Hinton
- University of California, Davis School of Medicine Sacramento CA USA
| | | | | | - Thu Ha Dang
- Swinburne University of Technology Melbourne VIC Australia
| | | | | | | | | | | | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- Dementia Centre for Research Collaboration, University of New South Wales (UNSW) Sydney Sydney NSW Australia
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Dang TH, Tran K, Esterman A, Roughead EE, Brodaty H, Hinton L, Kim GB, Kurrle S, Crotty M, Pham T, Le Pham T, Hoang P, Nguyen TA. Healthcare services for people with dementia in Vietnam: A situational analysis. Alzheimers Dement 2021. [DOI: 10.1002/alz.057659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Thu Ha Dang
- Peter MacCallum Cancer Centre Melbourne VIC Australia
- Swinburne University of Technology Melbourne VIC Australia
| | - Kham Tran
- University of South Australia Adelaide SA Australia
| | | | | | | | - Ladson Hinton
- University of California, Davis School of Medicine Sacramento CA USA
| | | | | | | | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
| | | | - Phuong Hoang
- University of South Australia Adelaide SA Australia
| | - Tuan Anh Nguyen
- Swinburne University of Technology Melbourne VIC Australia
- National Ageing Research Institution Melbourne VIC Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
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Nguyen TA, Tran K, Esterman A, Brodaty H, Hinton L, Dang TH, Kurrle S, Hoang P, Crotty M, Pham T, Kim GB, Le Pham T, Roughead EE. Reviewing the development of national dementia plans: Implications for Vietnam. Alzheimers Dement 2021. [DOI: 10.1002/alz.057579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tuan Anh Nguyen
- National Ageing Research Institution Melbourne VIC Australia
- Swinburne University of Technology Melbourne VIC Australia
- Health Strategy and Policy Institute of Vietnam Hanoi Viet Nam
| | - Kham Tran
- University of South Australia Adelaide SA Australia
| | | | | | - Ladson Hinton
- University of California, Davis School of Medicine Sacramento CA USA
| | - Thu Ha Dang
- Swinburne University of Technology Melbourne VIC Australia
- University of South Australia Adelaide SA Australia
| | | | - Phuong Hoang
- University of South Australia Adelaide SA Australia
| | | | - Thang Pham
- National Geriatric Hospital of Vietnam Hanoi Viet Nam
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Inacio MC, Jorissen RN, Wesselingh S, Sluggett JK, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M. Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study. BMJ Open 2021; 11:e057247. [PMID: 34789497 PMCID: PMC8601069 DOI: 10.1136/bmjopen-2021-057247] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles. DESIGN Retrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell's C-index assessed risk models' predictive ability. SETTING AND PARTICIPANTS Individuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs). PREDICTORS EXAMINED Individual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry. OUTCOME MEASURES 90-day unplanned hospitalisation and ED presentation post-RACF entry. RESULTS The cohort median age was 85 years old (IQR 80-89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell's C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications. CONCLUSIONS Within 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.
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Affiliation(s)
- Maria C Inacio
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - John Maddison
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - John Forward
- Northern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Alice Bourke
- Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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